Provider Demographics
NPI:1558664888
Name:LOUZON CHIROPRACTIC HEALTH CENTER PC
Entity Type:Organization
Organization Name:LOUZON CHIROPRACTIC HEALTH CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:T
Authorized Official - Last Name:LOUZON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:313-291-4646
Mailing Address - Street 1:21145 ECORSE RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-1836
Mailing Address - Country:US
Mailing Address - Phone:313-291-4646
Mailing Address - Fax:313-291-0019
Practice Address - Street 1:21145 ECORSE RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-1836
Practice Address - Country:US
Practice Address - Phone:313-291-4646
Practice Address - Fax:313-291-0019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005069111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
950H25128OtherBLUE CROSS OF MI
RR13810OtherRAILROAD MEDICARE
MI0H25128Medicare UPIN